Individual
ANNALIESE DIANNA ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, MSW
Contact information
Practice address
550 NW 3RD AVE STE BANDC, CANBY, OR 97013
(503) 342-2510
(503) 406-2637
Mailing address
7100 SW HAMPTON ST STE 128&129, TIGARD, OR 97223-8315
(503) 342-2510
(503) 406-2637
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7267
OR
Other
Enumeration date
07/09/2014
Last updated
05/24/2018
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